I use the above phrase to attack socialized medicine a lot. I’m not trying to be hostile or sarcastic when I say this. I’m not trying to convey an “America…love it or leave it” type message, nor am I interested in cutting off the debate about the problems with health care in this country, which I agree do exist. I say this to people who try preaching the doctrine of universal health coverage (or, more accurately, socialized medicine) because, frankly, I believe that the best counter-argument to their ridiculous proposal is for those people to go live for a few years in a country that has socialized medicine (as I did) so they can see for themselves what a horrifically bad idea it is.

To fill in the gaps a bit, I’m UCrawford. I’m a libertarian (small-l) from Wichita, Kansas and a guest poster here. Until 2006 I spent 10 years as a member of the United States military, just under six of them stationed at a small base in northern England (five if you don’t count a short vacation I took to Afghanistan on the Army’s dime). Due to the fact that the base I was on was both small and rather remote from any other U.S. bases we ended up falling between a lot of administrative cracks, most of which aren’t worth going into here, which often led to problems with funding. Needless to say, the U.S. government was often forced to improvise to provide quality of life services for us at a reasonable rate, so one of the solutions they came up with (since the closest base with medical services was 4-5 hours away) was to arrange to have all of our health care provided by Britain’s National Health Service (NHS). That decision provided all of the military personnel on our base with the unique experience of living under a system of socialized medicine that Michael Moore recently held up as among the best in the world. That decision also made it unlikely that anyone stationed at our base will ever end up in one of Moore’s little press conferences singing the praises of socialized medicine…the experience was terrible.

My first indication that something shady was up with our medical care came in my first year when I went into our base clinic (staffed by two NHS doctors) with a chest cold, only to be told that my cold was likely “viral” and wouldn’t require antibiotics. That in itself wasn’t really so odd. We worked in a close environment and doctors aren’t supposed to prescribe antibiotics for viruses. Except that after talking to other people on the base I eventually came to realize that about 90%+ of the people who went in with colds were told the same thing. I’m saying “90%+” because in the three years where the NHS staffed the clinic unchecked nobody I met on the base (I knew almost everyone and we all got sick at least once or twice a year because of the climate) could actually identify anyone who had been diagnosed with a non-viral cold or had received antibiotics for said cold. I’m not willing to bet there weren’t at least one or two in three years, although I never ran across any of these people. My platoon sergeant certainly wasn’t one of them. He later came down with severe pneumonia as a result of his untreated non-viral cold. I couldn’t figure out why this skinflint attitude towards medicine was happening, until I talked to my uncle (a doctor who had studied in Scotland for awhile) and he told me about the key to many of socialized medicine’s problems…controlling costs. More on that in a second.

The cost controls took a variety of forms at my base, ranging from the merely annoying (as when our base physician refused to order x-rays unless you had a bone sticking out of your arm), to the mildly amusing (as when the local hospital refused to admit our First Sergeant’s in-labor wife, forcing her and her husband to deliver the child in their car on the drive home), to the ethically questionable (as when one of my soldiers was discharged with a severe case of appendicitis on the grounds that surgery would be too expensive), to the medically indefensible (as when my best friend’s girlfriend nearly died because the hospital didn’t bother to check her for internal bleeding after a very complicated miscarriage). For the first couple of years, I thought it was because our area had the most incompetent doctors in Britain. Eventually I realized that the problems we had in our area were pretty much standard in comparison to the rest of the country (or compared to any country that uses socialized medicine). And the reasons for that are pretty simple.

Basically, the NHS’s “free” medical system isn’t really free at all, which shouldn’t be a surprise to anyone who doesn’t believe in magic money. It’s funded by taxes…income taxes, corporate taxes, capital gains taxes, property taxes, and hidden taxes (revenue generated for the national government from things like Value Added Tax, speed cameras, fuel taxes, and congestion charges that you often don’t notice or think of as taxes unless you’re paying attention). In exchange for all these taxes, the British government provides lots of services for the taxpayers like public transportation, a pension system, and socialized medicine, often at subsidized rates which has several regrettable effects:

1) It makes unobservant people who don’t understand economics think they’re getting a great deal by giving them medical treatment at a superficially low price, which
2) Pretty much insures that low-cost private alternatives don’t develop (since it’s tough to compete with “free”), which
3) Removes any incentive for the health care users to try and save costs by limiting their use since they see health care as a free (as opposed to “free”) entitlement, which means that
4) Demand for services often outpaces the ability of tax revenue available to pay for those services.

When these things happen government is then forced to find new streams of revenue to pay for the additional demand (more taxes). And when they can’t find more revenue or raise taxes any higher, they’re forced to control costs by reducing services where they can, by doing things like telling their doctors to prescribe less drugs, or understaffing medical facilities, or extending wait times for surgeries and consults (unless you’re willing to be extorted, of course), or starving terminal patients to death against their wishes, or skimping on oversight to insure that their doctors aren’t serial killers. Basically, when it comes to a choice between quality of care for patients or saving a buck, government-run health care will choose the money, same as socialized medicine proponents accuse private industry of doing. They’ll just offer you a lot less in return.

Unsurprisingly many Britons I knew had very little faith in the NHS’s commitment to excellence. Unsurprisingly many Britons I knew chose to pursue private routes to get medical treatment where it was available. Unsurprisingly, it was usually very expensive (partly because they were still paying taxes for a health care system they no longer used). Fortunately for us, after my soldier had to be medevac’d to the distant military hospital to get his appendix out, that base saw fit to provide our base with military doctors who had the authority to override the recommendations of the NHS doctors , and with the support of our command they enabled us to get access to private clinics in the local area more often. Frankly, I’d say that getting us away from government health care was one of the best things our government ever did for us. And if our politicians want to do the right thing by us back here in the States, they’ll do everything they can to stop socialized medicine from popping up here.

Like this:

Excellent post, very informative. You should write more about this, let people know about this to contrast The-Fat-Ass-From-Flint’s film.

http://dangerouslyidealistic.blogspot.com/ UCrawford

Thanks. To be honest, I never really paid much attention to socialized medicine until I lived over there. Now I consider it one of the most evil, destructive ideas of all time and it scares the hell out of me that it’s a mainstream issue in this presidential election. There are some things in life I’m willing to trust the government with (law enforcement, national defense, courts, roads), but trusting them with my medical care isn’t even a consideration.

Amy

Thanks for sharing your perspective. Your NHS experience is no different than what our Veterans experience in their homeland. Nor is it any different from the uninsured. Socialized Medicine has it ills and so does our current “free-market-socialized” system.

We need a better system.

So what’s the answer, and how many die/suffer while we argue the merits of a new system?

Brad R

“Basically, when it comes to a choice between quality of care for patients or saving a buck, government-run health care will choose the money, same as socialized medicine proponents accuse private industry of doing. They’ll just offer you a lot less in return.”

On that, the kicker too is that when the private industry choosing money and providing quality of care go hand in hand, because if you offer terrible service, you don’t get the money. The government doesn’t care, however. They’re going to get it whether you like it or not.

http://dangerouslyidealistic.blogspot.com/ UCrawford

Amy,

Geez, where to start on a response to this. It would probably take a series of posts and debates just to address all the major issues of health-care reform, to say nothing of the unintended consequences.

My short reply to you is that I don’t believe the state of health care in the U.S. is at a point where we need to rush poorly-thought-out reform measures through just to claim we’re doing something. People aren’t dying in the streets in droves (like in North Korea or Zimbabwe), a lot of the numbers of the “uninsured” have been skewed or distorted by people like Moore, we aren’t running short of drugs or services on a regular basis, insurance for catastrophic medical coverage is often available at a reasonable price, and even if the cost of everyday health care is often high right now the health care is still available if you’re able to pay for it or (worst case scenario) go into debt.

We already have a quality of health care favorably comparable to Europe or anywhere else in the world and our problems are merely different than countries living under full socialized medicine, not worse. Actually, under the current health system our country is able to provide the lion’s share of the world’s advances in new drugs and medical technologies…which would dry up once you remove the profit motive from the private medical industries. In fact, one of the reasons most of the countries with full socialized medicine haven’t deteriorated any further is because they’re able to piggyback off medical innovations that our private medical industry produces.

For ideas on what to do about fixing our system, I think the first place we should start looking is at where the overhead for medical providers comes from. What are their costs? What generates those costs? How much of those costs are already caused by government regulation? I’m betting that the answer to the last question is probably “a large chunk of it” when you take into account restrictions and delays caused by government entities like, for example, the FDA (who drive up the prices of new drugs with an excessively long and arduous approval timetable). I’m betting that if we start digging down into it a lot of the problems we have with our medical system are usually the result of the government screwing us, not the doctors and drug companies. And that’s a debate that would need to be held over a long series of discussions, because it’s a topic that would require a lot more analysis (very honest analysis) than you’re likely to get from an eight paragraph post or a two hour “documentary”.

http://dangerouslyidealistic.blogspot.com/ UCrawford

Amy,

Also I agree with you about socialized medicine being no different than what our veterans get. Actually, I wrote a post on it on my site awhile ago and noted that the military medical system was a good bellwether for us to see what what socialized medicine in this country would be like. Incidents like what happened at Walter Reed or the huge backlog of disability claims aren’t unusual in a system of socialized medicine, they’re actually very common and usually a result of government cost-cutting. If you’re a regular reader of a publication like Army Times (a trade magazine for soldiers) you’d have been well aware of shortfalls in the V.A. programs long before the story broke in the MSM…after all, the Bush administration had been slashing the V.A. budget for two years, under the laughable claim that disability claims and the need for medical treatment would actually drop in the middle of a shooting war. But before the Walter Reed incident popped up, few people outside the military were paying attention, so the Bush administration figured that cutting back on V.A. benefits was a good way to cook the books without attracting any undue attention. That happens frequently in socialized medicine…government tries to cut costs in areas where people either won’t notice or won’t bitch and hope it doesn’t catch up to them.

Although I think your experience is valid, it’s just one person’s experience. If you want to make broad overarching claims about the healthcare system you should do a more thorough broad analysis. Otherwise, you end up making the same sorts of mistakes Michael Moore makes but with even less information than what he draws from.

From the doctors I’ve talked with it sounds like the insurance system is a lot of the problem because of the types of incentives it creates.

Incidentally I know a number of Americans living in Europe who have no problems with their healthcare systems. But I do hope we don’t try to use them as a model. I think our system is unique and requires solutions that would work here which I think would rule out a typical socialized medicine paradigm.

At the moment we pay for catastrophic healthcare for the uninsured while not allowing them any options for preventative care. This is poor, poor use of money and really stupid.

Yes, my story is anecdotal and first-hand…that’s why I was asked to write about it. I didn’t have to rely on the second-hand stories of people I knew in Europe because I was able to witness many of these situations. And I linked to sources demonstrating that the incidents I encountered in socialized medicine were not limited to me. Did you bother to read the links? As for the “broad, overreaching” nature of the article, I already said that a realistic discussion of health care couldn’t be broken down in one post or one documentary. So nice work repeating my comment and claiming it as your own idea, Mr. White Noise. Maybe next you can tell me how my story would seem to indicate that I once lived in England.

If you want to start a debate on the pros and cons of private health care, then how about a specific criticism as a starting point somewhere? You mentioned the insurance industry as being part of the problem, do you want to expand on that or is everyone just supposed to guess at your non-sequitur? Tossing in a link or two for additional information would be nice as well…that’s what people do when they have serious debates, try to gather information and cite reputable sources. Also, in the interests of helping you hone your argument, here’s a link for you on logical fallacies (http://www.csun.edu/~dgw61315/fallacies.html). I think it’ll prove useful to you, I found three of them in your response.

ed

OK, so what is your answer to the problem? For the past 7 years my payments have risen by double digit numbers. My insurance costs have doubled in those 7 years. My cost of living over those 7 years was less than 20%. Talk about problems with our current medical insurance companies making incorrect diagnois, to insurance companies not allowing my friends procedures requested by doctors, & to being ripped off by the drug industry. So what should we do? I believe all Americans should have access to medical assistance (JAMA agrees) without losing their homes or if they have nothing their lives. We do have public education for everyone along with police etc. Can we put a stop to such outrages premium costs? Can we take the insurance company out of the picture? Should we go to a gov’t. ststem that we pay into. The problem is greed and the health industry is going to push us into a corner and they/we will lose.

http://dangerouslyidealistic.blogspot.com/ UCrawford

Ed,

Well, I think a good starting point for discussion on reform would actually be President Bush’s proposal for health care reform from his 2007 State of the Union address. He proposed making money paid by employer-provided insurance taxable income, then allowing up to $7,000 in medical expenditures every year to be claimed as a tax deduction for all Americans (regardless of who their insurer was). The aim of this program was to make a minimal change in tax code to break the stranglehold of employer-provided health care on the market and make it more economically feasible for private individuals to seek their own health care independent of their employers. As it stands now, employer-provided health care is simply a way to pay employees additional wages without the employees having to pay taxes, and it tends to favor large companies (who can afford those plans) over smaller companies or the self-employed (who can’t). This penalizes people who work for companies that don’t offer employer-funded health care and harms the market for insurance plans for private individuals.

I thought it was a good solution, it’s a pity that Bush never really cared about following through on it. The Cato Institute was also bullish on the Bush proposal:

And all Americans already do have access to medical care. It’s just that, like any other product, you have to pay for it…same as you pay for food, or electricity, or someone to fix your car. And that wouldn’t change under socialized medicine, the only thing that would change is the amount of taxes you pay (more) and the quality of health care you’re able to receive (less).

The argument it seems that you have is the amount of money we need to pay for these services, which I have a problem with as well. So the question is how to reduce cost to make it more affordable while giving the most people access to quality health care. Socialized medicine isn’t the answer to this because it’s not actually reducing costs, it’s just hiding the expenditures by taking the payment as taxes while offering lower-quality service. That’s not a good tradeoff. My argument is that much of the exorbitant cost is the result of government intervention (such as the FDA’s drug-approval process, to cite one) and if we want to look at reducing the price of medical care without reducing the quality of medical care we should look at de-regulating first because that’s the area where money is most usually wasted.

http://dangerouslyidealistic.blogspot.com/ UCrawford

Also, if we want to minimize the insurance industry’s influence, it wouldn’t be a bad idea to repeal any laws that require all individuals to have health insurance. Perhaps I misinterpreted basic economics, but it was always my impression that when people are forced to buy your product that removes most of the incentive to offer your product at a competitive price. Basically, those laws help to create coercive monopolies that harm consumers and the markets and help to drive prices up. Just my random thought on that subject.

http://www.thelibertypapers.org/ Stephen Littau

Great job UCrawford!

Mike:

The reason why I invited UCrawford to write a post here was because of his personal experiences and insights he gained in dealing with the NHS. He did however go beyond this and provide some links to back up his points. I wanted his perspective because I have not experienced what he has; all I have to go on is what I have read. The pro-socialized medicine crowd is always trotting out these heartbreaking stories about our healthcare system and/or showing only positive stories in countries that have socialized healthcare. By no means is UCrawford’s post an exhaustive treatise on healthcare, nor was it intended to be but more of a starting point for this discussion. I just wanted the readers to see the side they do not normally see in the MSM.

Ed:

I can definitely sympathize with your situation. I’m personally paying through the nose for healthcare. I do not believe the solution is socialized medicine, however. There are several factors that contribute to the high cost of healthcare such as malpractice lawsuits (which in turn means expensive malpractice insurance), patients who do not pay their bill (which raises the costs for the rest of us), and government regulation. Of these three, government regulation is causing us the most harm and contributes to the other two.

The government forces insurance companies to cover certain things such as mental health, drug and alcohol secession, and a variety of other things (some of this varies state to state). The FDA contributes a great deal of expense in how it regulates drugs which adds a great deal of costs to R&D for the drug companies (most drugs never make it to market), yet how many drugs have made it to market with dangerous side effects despite these rigorous measures?

In my mind, the answer is for less government, not more. Individuals should have the ability to buy any insurance plan they want with the level of risk they are willing to accept. A younger person has very different needs than an elderly person when it comes to healthcare. A younger person should have the ability to buy catastrophic coverage and pay out of pocket any health services s/he needs. An elderly person would probably want more coverage. Insurance companies should also have the ability to give discounts for individuals who do not use illicit drugs, who don’t smoke or drink excessively, are at their ideal weight, and otherwise take preventative measures for their health. Individuals who choose to take more lifestyle risks should have the ability to pay more or sign waivers for health problems which result from these risk factors.

If we were to take this approach rather than the one size fits all approach, we would have better access to health insurance at a better price.

http://dangerouslyidealistic.blogspot.com/ UCrawford

Thanks Steve.

And I think you really nailed it with your reply. The problem with socialized medicine is that it’s a top-down system that attempts to have a relatively small group of leaders predict all possible medical situations and propose one-size fits all solutions and regulations. Adam Smith demonstrated a long time ago that this (centralized control for the common good) does not work. It’s not simply that socialized medicine hasn’t been properly implemented, or underfunded, or mismanaged. It’s that self-interest and the law of unintended consequences make a successful system of socialized medicine impossible to implement at all…it’s inherently flawed. And most of the problems we have with the private medical industry in this country are as a result of politicians attempting to apply top-down management to that industry.

As for people who claim that medical care should be free, as Robert Heinlein once wrote “Nothing of value is free”. Not under private health care and not under socialized medicine. The only question is, which system is going to provide you the best quality product at the best actual price?

TanGeng

When I studied the economics of the health care – health insurance industry, I learned about a variety of topics contributing to the high cost of health insurance. I read about individual risks, aggregate risks, group rates, profit motives, coverage, etc. When the topic of coverage came up, the idea of a moral hazard came up quite often.

Essential higher rates of coverage (lower copays, lower deductibles, etc) leads to increasing higher usage of medical care. The higher usage of medical care leads to higher costs and a more expensive health care system. At the same time, the aging American population has produced a population that has a larger and larger aggregate risk profile.

The insurance industry can use two different methods to maintain a healthy balance sheet in face of rising expenditures. It has raised premiums, raised copays, and raised deductibles. Insurance companies have done this where ever they can.

The insurance industry has also employed the most annoying tactic of challenging all health insurance claims in almost an unreasonable manner. They force patients to provide an excessive amount of documentation or they force doctors to provide an excessive amount of documentation to prove that the procedures were truly necessary.

Under a socialized health system, the coverage rate is 100% – no copays, no deductibles, 100% coverage. Under this system, the moral hazard is even larger, and it suggests a combination of even higher costs for health care and even more annoying tactics to prevent the usage of health care.

Society will merely recover the profits that insurance companies and private hospital management companies make under the current system. But removing the profit motive in health care hampers innovation in the health care industry. We will have strangled the chances of inventing cost effective methods in health care.

Quincy

UCrawford –

Thanks for your insightful writing on this issue. Medicine here is already to socialized, in the sense that the costs of health care are obfuscated by government regulation, i.e. the tax code, and the meddling by government do-gooders when it comes to minimum coverage levels. I continually wonder why I, as a young, single male, need to carry insurance for gynecological issues. The answer, I was told by HR, was that those are the plans my company has chosen to offer its employees. I pay for coverage I literally can never use, and it’s all because of the federal tax code punishing people who want to pay for their own health care. Inanity and waste such as this will only grow worse in a system further removed from the consumer.